The sad tale of how Shohei Ohtani's torn elbow ligament ruined baseball's best story of 2018

Inside his office, above the oversized, high-definition monitor where he shows injured baseball players images of their damaged elbow ligaments, Dr. Naotaka Mamizuka hung a row of photographs. Most were him posing with patients, famous athletes in Japan, celebrities, the sorts who would elicit an ooh or an aah from the everyday people he saw. One person in particular stood out to his clientele.

“That’s Ohtani,” Mamizuka said. “Do you know him?”

I did. Everybody in the baseball world knew Shohei Ohtani. It was August 2014, and I was in Mito, a two-hour train ride from Tokyo up the east coast of Japan, where Mamizuka practiced. He spent most of his time performing spinal surgeries. Twice a week, for four hours a day, baseball players would flood his office – up to two dozen a day, if he could cram them into his schedule, and occasionally fewer, if someone important was coming to visit.

Shohei Ohtani qualified as important. He was 20 years old, in the midst of his first full season with the Hokkaido Nippon Ham Fighters, and was the future of Japanese baseball. His fastball regularly clocked in at 100 mph, sometimes faster, harder than any Japanese pitcher ever had thrown. He could also hit, with rare power in a league that produces scant sluggers. He had seen Mamizuka to get a sense of his arm’s health. All was well.

This heartened Mamizuka. It also scared him. He had seen thousands of elbow MRIs, turning a curiosity in baseball medicine into an expertise perhaps unmatched in Japan. That day he examined 20 children, ages 9 to 17. He diagnosed injuries in 19 of them. Japanese baseball, a year-round pursuit in which the best teams practice 360 days a year, taking a short break only at Christmastime, runs through elbow ligaments with the efficiency of a plow through dirt. That Ohtani escaped without severe damage to his ulnar collateral ligament, the triangular band of tissue that holds together the upper and lower bones of the arm and allows man to throw a baseball, felt to Mamizuka something of a miracle. Like, maybe this athlete blessed with the ability to throw like few others and hit with great force happens to be the outlier with regard to injury, too.

Angels starter Shohei Ohtani watches a pitch during the third inning of his game against the Royals (AP).

But then he considered all he knew about the elbow, about Ohtani, about the intersection of this fallible piece of tissue with this capacity to throw a ball at amazing speeds, and he harkened back to something he said earlier in the day, when he was imploring a 16-year-old with arm pain not to throw with maximum effort.

“Power is bad,” Mamizuka said. “Power is bad.”

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Nobody knows for certain what causes UCLs to break. It is some combination of usage, movement, velocity and genetics, and it differs in every player. Players in Japan, and in travel-ball-heavy areas of the United States, suffer because ignorant – or, quite often, selfish – coaches abuse their arms with impunity. Others’ movement patterns – mechanics, as they’re most often deemed – cause excessive stress and strain and lead to a fraying or acute tearing of the ligament. The speed of one’s fastball correlates strongly with UCL damage, though it’s not as simple as throw hard, get hurt. DNA’s role remains a mystery, but doctors and researchers agree that some players are simply born damned and others hearty enough to withstand extremes in other areas.

Exactly what caused Shohei Ohtani’s UCL to break doesn’t matter so much as the fact that it’s broken. The Los Angeles Angels announced Friday that two months into Ohtani’s career in Major League Baseball, he has a grade-2 sprain of the UCL – a partial tear significant enough to warrant Tommy John surgery in thousands of others, from junior high to the major leagues, who have received the same diagnosis. The Angels knew this was a possibility, knew that he had undergone a platelet-rich plasma shot in his elbow in October after being diagnosed with a first-degree sprain, knew that the combination of Japanese usage, his dynamic fastball and a previous injury made him especially susceptible to more.

The plan – another PRP shot, three weeks of rest, reassess – is exactly what the Angels should be doing. On a conference call, their general manager, Billy Eppler, spoke with a rare expertise about UCL injuries, parrying a question about Ohtani’s split-fingered fastball perhaps being the culprit by saying the research on the subject simply doesn’t support the notion that splitters cause Tommy John surgery. He offered faith in PRP, a treatment that takes blood spun in a centrifuge to concentrate its growth factors, then injects it into the elbow hopeful it will help repair the damage. He also wasn’t irrationally optimistic. When asked if he believed Ohtani could avoid Tommy John surgery, the reconstructive procedure named after the first patient to undergo it, Eppler said: “We’re hopeful that he can.”

The news of further damage to Ohtani’s UCL arrived Friday afternoon with great sadness for a sport that had spent the first third of the season marveling at his arrival. He was the best story in baseball, a flame-throwing slugger with elite speed, as if manufactured in some facility that existed solely to create the archetypal ballplayer. The All-Star Game was going to be Ohtani’s best chance yet to cultivate the national following a player of his abilities warrants. Now, best-case scenario, he’ll be back sometime in July, though that would take the PRP shot working and an incredibly aggressive rehabilitation schedule.

And considering Ohtani’s import to the Angels, and their conservatism with him as the season has progressed, they’re unlikely to push him back. A grade-2 UCL sprain is no joke. While full-thickness tears of the UCL – the grade-3 variety – always require Tommy John surgery, players who don’t respond to initial treatment are given a choice: continue rehab in hopes it improves or undergo the surgery.

The timing of the injury actually gives Ohtani a fair bit of flexibility should the PRP not take. Were he to undergo Tommy John surgery in early July, he almost certainly would miss all of 2019 as well, based on the Angels’ history of handling returns from the procedure with excessive caution. Andrew Heaney took 14 months to return, Nick Tropeano 20 months and Tyler Skaggs 23 months. And that’s to say nothing of Garrett Richards, who suffered a partial UCL tear, received an injection of stem cells mixed with PRP and returned 11 months later.

Shohei Ohtani left the game against the Royals after four innings with a blister on his middle finger. (AP)

The incentive to head straight for the operating table, then, is lessened by the calendar. Ohtani could rehab in June, July and August in hopes that by September the ligament has healed enough to allow a return. Masahiro Tanaka partially tore his UCL in July 2014, received a PRP shot, returned by the end of September and hasn’t had a significant recurrence since. If that doesn’t work – if the healing is slow or nonexistent – Ohtani could opt for the surgery then and give himself 17 months of runway before spring training 2020.

Which might as well be a million years away. These Angels were built to win and win now, Ohtani the perfect complement to Mike Trout and the perfect marketing tool for MLB and the perfect person to grow the game internationally if not for the imperfection in his right elbow.

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All of this started with a blister on, appropriately, the middle finger. Ohtani left his last start against the Kansas City Royals following four solid innings that lowered his season ERA to 3.10. “He was up getting that blister drained,” Eppler said, “and as the game adrenaline wore off, he then said, ‘My elbow’s getting a little stiff.’ ” The Angels sent Ohtani for an MRI, the scan revealed the tear and so began the latest episode of Why Can’t We Have Nice Things?

It’s happened a lot this year. The Angels have lost closer Keynan Middleton, starter J.C. Ramirez and reliever Blake Wood to Tommy John. Three young Rays starting prospects, Brent Honeywell, Jose DeLeon and Anthony Banda, all tore their UCLs. Taijuan Walker, Dinelson Lamet, Jordan Montgomery – all 25 years old, all broken down. And that’s to say nothing of the zipper-scarred pitchers from baseball’s recent past. John Smoltz and Stephen Strasburg returned to carve out wonderful careers. Matt Harvey and hundreds of others not so much.

Every UCL injury is a reminder not just of the arm’s fallibility but baseball’s inability to outline a youth-to-pros plan that lessens the number of pitchers whose arms simply cannot stand up to the expectations of the sport’s max-effort, max-velocity culture. When it shelves anyone, it’s problematic. When it waylays the game’s most fascinating character, the damage runs far deeper.

Even if it was somewhat preordained – grade-1 tears wind up grades 2 or 3 regularly – there was still, among the masses who have been smitten by Ohtani, almost a willful blindness to the possibility that it would happen now, this soon, like the elbow wouldn’t dare ruin a season like this. By now it should be obvious that the elbow spares no one, not even a person who leverages it into doing special things.

No, it’s unforgiving and apologetic to no one and snagged another victim this week, and for all the hope that the PRP takes or that rest works its magic, the best Eppler could muster was “hopeful.” Kind of like Dr. Naotaka Mamizuka four years ago, when he pondered Shohei Ohtani, his young patient, the one with the arm and the bat and the most important part of all, the health. The kid who seemed to have everything until he didn’t.